A lingering constitutional crisis in Haiti that has triggered protests, unrest, and bureaucratic chaos is overshadowing the country’s COVID-19 vaccine rollout – and fanning a vaccine hesitancy that has also led to fewer immunisations against preventable diseases.
“What we see from recent data is that there is a huge drop in acceptance of injections,” Yves Sassenrath, country director of the United Nations Population Fund, or UNFPA, told The New Humanitarian. “The immunisation sector is being hit in Haiti by lack of trust in the health system, misinformation, access issues, fear – in terms of violence – and fake news.”
Haiti already had weak immunisation participation for vaccine-preventable diseases – such as diphtheria and tuberculosis – before the pandemic, but recent frustration with the government is driving up resistance to COVID-19 vaccines, aid workers from at least three organisations told TNH, referring to reports they had received.
“I will be the last person in line for the vaccine,” Maxo Blan, a 41-year-old mechanic, told TNH, noting that his reticence came from government mistrust, as well as an incident in the mid-1990s when more than 60 children died after drinking contaminated cough medicine.
Haiti has been without a parliament since January 2020, when lawmakers’ terms expired without elections. Since then, President Jovenel Moïse has ruled by decree amid growing calls to resign, set against a cascade of street protests, and escalating gang violence and kidnappings.
The pandemic, meanwhile, has amplified Haiti’s many humanitarian needs, which have been put on a par with those of South Sudan and Central African Republic: Some 40 percent of the population is in need of assistance, food insecurity remains acute, and the paralysing protests have further damaged an economy that was already reeling from high inflation rates.
“[Government officials] say they will feed people and give them jobs, but if you're not honouring that, people will not trust the vaccine you are giving,” Jean-Bernard Tellier, a 36-year-old motorcycle taxi driver, told TNH.
So far, Haiti has been spared high COVID-19 death tolls – fewer than 300 people have died since the start of the pandemic – largely attributed to the fact that more than half of Haiti’s 11 million population are under the age of 24. Conversely, the Dominican Republic – which shares the same island – has seen more than 3,226 deaths and 246,299 cases, many linked to its booming tourism industry.
Although Haiti has seen fewer than 13,000 confirmed COVID-19 cases, it has also only administered 53,000 tests since the start of the pandemic. The Dominican Republic, by comparison, has administered more than 1.2 million tests.
UNICEF’s country director in Haiti, Bruno Maes, told TNH there was a seven percent increase in maternal deaths in the first half of 2020 compared to the same period in 2019. First prenatal consultations decreased by 40 percent, with deliveries by skilled health personnel decreasing by some 50 percent, he said, adding that routine immunisations had also dropped by up to 40 percent during the past year.
But with limited data, it’s unclear how many excess deaths there may have been, and which may have been caused by the coronavirus itself or from people not seeking medical treatment in the midst of lockdown restrictions, political unrest, or fears relating to the pandemic.
Unlike in the neighbouring Dominican Republic, where the vaccine rollout has already begun, no details of Haiti’s vaccine shipments or vaccination plans have been released.
Haitian health officials declined to answer specific questions from TNH about the rollout. Haiti, like other countries, is expected to receive vaccine shipments as part of the COVAX programme, which was created with the goal of ensuring equal vaccine access globally.
Viral conspiracy videos have been shared on WhatsApp groups claiming that the vaccine transmits HIV/AIDS and malaria – Haiti has some of the highest malaria rates in the Caribbean and Central America. On Twitter, Haitian influencers have conducted polls on the vaccine, with followers overwhelmingly rejecting it.
Mercy Corps Country Director Justin Colvard told TNH they have been tracking how the rumours and disinformation in Haiti have evolved. “At first, it was that COVID-19 was not real, and that if it was real, Haitians were invulnerable to it,” Colvard said. “The government was then accused of using it to get more international aid.”
“If it was a government in which people trusted, people would be open to the vaccine.”
Some $151 million worth of aid went missing after the 2010 Haiti earthquake that killed between 100,000 and 300,000 people.
Jean Eddy Saint Paul, professor of sociology at CUNY Brooklyn College, said vaccine hesitancy in Haiti is complicated – there has long been a deep mistrust of foreign meddling due to Haiti’s colonial past, but there has also been little tolerance for leaders who fail to deliver on promises before asking even more of the masses.
“If it was a government in which people trusted, people would be open to the vaccine,” Saint Paul said. Some also fear vaccines will be used to curb birth rates and “depopulate” the world of Haitians, the professor added. Sassenrath of UNFPA said there was some evidence that more Haitian women were opting not to get birth control injections, but the data was limited.
Calls for Moïse to step down came shortly after he was elected to a five-year term in 2016 – a previous election was cancelled in 2015 due to allegations of electoral fraud. Critics say his term should have ended on 7 February 2021, but as he didn’t take office until 2017, Moïse insists it ends in 2022 – a claim supported by the Organization of American States regional bloc and by US President Joe Biden’s administration.
A company linked to Moïse, other government officials, and heads of private firms were accused in an auditors’ report of embezzling $2 billion from Petrocaribe – a cut-price-oil aid programme that Venezuela offered to several Caribbean countries. For Haiti, the savings offered the chance to rebuild after the 2010 earthquake.
“Trust takes time to build,” Saint Paul said. “It is through the implementation of new policies – policies that actually are responding to the real need of the Haitian people.”
Haitians have also grown accustomed to dealing with health needs largely on their own. Some 10,000 people died in a cholera outbreak linked to UN peacekeepers after the earthquake.
“Much of what we heard in the months after cholera… we are hearing [now],” said Colvard, noting that people often report having a fever and then recovering without ever getting tested to determine what the ailment was.
Everyone just calls it “the fever”, said Dr. Ralph Ternier for Partners in Health, a Boston-based non-profit known in Haiti as “Zanmi Lasante” that has been offering free COVID-19 tests and care. “Most people won’t go to the hospital for a fever or flu.”
But some have gone to the hospital to get treatment and haven’t recovered, which has also raised fears of seeking medical help or vaccinations.
“Another rumour that we have gotten has been that any injections you get from a COVID-19 clinic will cause harm to a patient because they have seen that when people go in to get treated from COVID a lot of them die,” Colvard said. “That is because they are going in quite late, and the health system in Haiti does not have a lot of resources.”
But the larger crisis for many in Haiti right now is political. Roly Jolie, a 23-year-old university student in Port-au-Prince, told TNH that unless the current stalemate passes and order is restored, COVID-19 will stay on the backburner.
“We need stability and a government we can trust before we can start to think about the pandemic and everything else that is going wrong in this country.”
TNH Investigations Editor Paisley Dodds contributed to this report.